The Long Leash of Sexual Liberty

By Dr. Drew Pinsky

Photography by Trey Wright

July 20, 2016

Over the past 50 years, Western culture has seen unprecedented progress in our sense of ourselves as sexual beings. The so-called sexual revolution, with its rejection of puritanical values and embrace of “free love,” enriched our ability to be open about our sexual orientation, gender identity and sexual practices with vastly reduced shame and judgment. But the unintended consequences of this revolution continue to unfold in a dazzling array of manifestations—among them teen pregnancy, internet pornography, Tinder, sexual addiction, epidemics of sexually transmitted diseases and a frequently impoverished interpersonal landscape.

As a physician, I’m always alert to the biological contexts of cultural change. At least some of the attitudes about sexuality that we’ve transmitted across generations have a basis in biological reality. A good deal of ink has been spilled suggesting it was the advent of hormonal contraceptives (a.k.a. the pill) that allowed women to have mastery over their reproductive potential. And one must remember that throughout human history, a significant percentage of women died in childbirth. When obstetric and medical advances decreased this threat, sex was uncoupled from reproduction for the first time. This certainly contributed to the freedom we’ve enjoyed since.

But other rarely addressed phenomena have also influenced our freedom of sexual expression. Foremost, I suggest, is the invention of antibiotics. Throughout human history the medical consequences of sexual contact were protean and dire. Prior to antibiotic treatment, even something as simple as a urinary tract infection came with the hazard of serious medical complications, even death. Gonorrhea, chlamydia and syphilis were virtually untreatable. Knowing well the intensity of libidinous desires, you can imagine that if you were the parent of young adults in a pre-antibiotic era, you would be sure to instill in your children a healthy fear of sexual contact. Their lives would be at stake.

We now largely enjoy freedom from the complications of these infections when properly treated, and our sexual mores have evolved in a new biological context. I’m not suggesting that cultural attitudes don’t also restrain us; I am suggesting that those attitudes may have had biological roots that modern medical science has upended, allowing for a new range of freedom of expression.

Another important consideration is the very nature of freedom itself. Increasingly, neurobiological insights are calling into question precisely what we mean by free will. Freedom, as our founding fathers conceived it, was freedom from external oppression, freedom from tyranny, freedom to pursue our life’s work unencumbered by arbitrary restraint. Gradually, we have expanded our sense of freedom to include the freedom implied by equality and choice. These are complex topics, and I don’t mean to reduce them to empty shibboleths. But I do wish to mention that our free will is at a minimum influenced, if not completely constrained, by neurobiological forces well outside of consciousness. Functional MRI data show that our brain makes choices and drives behavior long before consulting consciousness. Still, though we are undoubtedly under the influence of many biological forces, we have moments of relative choice; in other words, we can make choices somewhat freely, but the desires behind these choices are not under our control. You can choose to eat pizza every day, but you cannot will yourself to love pizza.

From my decades of clinical experience, I know that many processes can shape or adulterate our sexuality and thus our genuine freedom of expression. Childhood trauma has a profound effect on our adult sexual desires and behaviors. We are loath to admit it, but it is simply a feature of the human experience that traumatic experiences in childhood often lead to traumatic reenactments in our adult lives. We end up becoming attracted to individuals and circumstances that recapitulate our childhood experiences. This is deeply entrenched in our biology. Reducing the dangers of pregnancy and removing many of the complications of bacterial STIs have made it easier to detect this compulsion to repeat. When you see people making the same “mistakes” over and over again, look for trauma.

As with most realities of the human experience, the law of unintended consequences always lurks near at hand when there is change. Our sexual freedoms have undoubtedly enhanced many aspects of intimacy. I do not mean to diminish the benefits of being able to more easily assert one’s sexual preferences. And I am not Pollyannaish about work yet to be done to help further free those who feel the sting of sexual repression. I do, however, believe we should take an honest inventory of the forces that brought us here and continue to examine the phenomena that come to bear on our freedoms of sexuality and desire. The human experience is rich with revelations—many of them hiding behind the veil of the unexamined life.

Dr. Drew Pinsky is a practicing physician and addiction specialist whose call-in show Loveline was on the air for more than 30 years.